# The potential for patient-reported data and narratives to improve quality during emergency department boarding

## TL;DR

This paper explores how collecting patient-reported data from those waiting in emergency departments can improve care quality during boarding.

## Contribution

The study introduces the use of patient-reported outcomes and narratives from boarded patients to inform quality improvement in emergency departments.

## Key findings

- Longer ED stays correlate with lower patient-reported diagnostic quality scores.
- Patient narratives highlight communication issues during boarding, such as lack of explanation for hospital admission.
- Including boarded patients in surveys could provide actionable insights for improving ED boarding practices.

## Abstract

Emergency department (ED) boarding, the holding of admitted patients in the ED due to unavailable inpatient beds, is a growing challenge linked to poorer patient outcomes. Traditional patient experience surveys, such as the ED Consumer Assessment of Healthcare Providers and Systems (ED CAHPS), exclude insights from boarded patients, whose experiences could inform quality improvement efforts. We collected data using the patient-reported outcomes to improve diagnostic experience in the ED instrument from all patients, whether discharged or admitted. Early findings show that longer ED stays correlate with lower patient-reported diagnostic quality scores, with the highest quartile of stay durations averaging 3.79 out of 5 compared to 4.10 in the lowest quartile. A separate nationwide survey of diagnostic experiences, which did not specifically ask about EDs or wait times, also highlighted the impact of long ED stays. Patient narratives emphasized the need for better communication during boarding, such as explaining the reasons for admission. These findings suggest that including boarded patients in ED CAHPS' sampling criteria and incorporating open-ended questions could provide valuable insights for improving ED boarding practices. This commentary emphasizes the value of patient-driven data in identifying actionable solutions to mitigate the challenges of ED boarding.

Surprisingly, patient experience data are not routinely collected from patients who must “board” in the ED after hospital admission when waiting for transfer to their hospital room. From recent research, lower patient-reported diagnostic quality scores correlate with longer ED stays, and patients report communication issues such as failure to explain the rationale for hospital admission during boarding. Continued research on and implementation of patient-driven metrics would provide critical insights to guide practice and policy related to ED boarding challenges.